Comparison of Proposed 2027 OPPS Addendum A with July 2026 Addendum A
HFMA provides a spreadsheet comparing relative weights and payment rates at the APC level, using the 2027 OPPS proposed rule Addendum A compared to 2026 Addendum A.
Medicaid provider tax proposed rule could cut payments by $220 billion over 10 years
A proposed rule from CMS implements anticipated changes to the system of provider taxes that help fund supplemental reimbursement in Medicaid. The changes are required under the One Big Beautiful Bill Act (OBBBA, also referred to as the Working Families Tax Cut legislation), with the proposed rule filling in details. The repercussions of the rule…
MultiPlan antitrust litigation gains momentum after rulings for providers
Healthcare providers obtained two favorable rulings over the last month in their massive antitrust litigation against a vendor’s repricing algorithm. The case entails allegations that MultiPlan — which since has rebranded as Claritev — conspired to set out-of-network (OON) payment rates by gathering competitively sensitive information from roughly 700 health plans and using that information…
Judge blocks key ACA marketplace rule provisions for 2027
For the second consecutive year, a federal judge has provided relief to plaintiffs challenging Trump administration regulations that are intended to tighten limits on Affordable Care Act (ACA) marketplace coverage. A July 16 ruling by Judge Brendan Hurson with the U.S. District Court for Maryland halted implementation of key provisions in recently finalized regulations that…
Comparison of Proposed 2027 ASC Addendum BB to 2026 Addendum BB
This spreadsheet compares ASC covered ancillary services integral to covered surgical procedures, using 2027 proposed rule Addendum BB compared to 2026 Addendum BB.
Comparison of Proposed 2027 ASC Addendum AA to 2026 Addendum AA
This spreadsheet compares relative weights and payment rates for ASC covered surgical procedures at the HCPCS level, using the 2027 proposed rule Addendum AA compared to 2026 Addendum AA.
2027 Medicare Physician Fee Schedule proposed rule includes broad payment changes
Physicians will incur a payment decrease in 2027 unless Congress intervenes, according to a CMS proposed rule issued July 14 for the Medicare Physician Fee Schedule. Statutory provisions call for increases of 0.75% for clinicians participating in advanced alternative payment models (APMs) and 0.25% for nonparticipants. However, those raises and a 0.53% bump stemming from…
CY 2027 OPPS/ASC Proposed Rule Summary
HFMA presents a detailed summary of the proposed rule published by CMS on July 7, 2026, updating OPPS payment policies that apply to outpatient services provided to Medicare beneficiaries.
Medicare skin substitute reimbursement changes have raised provider risks
A formerly high-revenue healthcare service has been diminished on several fronts in 2026. Medicare Part B spending on skin substitutes increased by 640% between 2022 and 2024, reaching nearly $3 billion per quarter, according to a government report. Steps taken by CMS and policymakers to counter that trend include an overhauled payment system and an…
Cost saving strategies, a more modern patient experience and more
Nick Hut discusses the Medicare OPPS Proposed Rule with Kathy Stull. Erika Grotto talks with Michael Driscoll of Fidelity Investments about cost saving strategies for employers and with Tracy Monson from Onbe about modernizing the patient financial experience.